Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
Charles E. Schmidt College of Medicine, Boca Raton, FL, USA.
Breast Cancer Res Treat. 2020 Aug;183(1):127-136. doi: 10.1007/s10549-020-05747-7. Epub 2020 Jun 30.
To explore the optimal type of breast reconstruction and the time interval to postmastectomy radiotherapy (PMRT) associated with lower complications in breast cancer patients receiving neoadjuvant chemotherapy.
We reviewed the medical records of 300 patients who received neoadjuvant chemotherapy, mastectomy with breast reconstruction and PMRT at our institution from 2000 to 2017. Reconstruction types included autologous flaps (AR), single-stage-direct-to-implant and two-stages expander/implant (TE/I). The primary endpoint was the rate of reconstruction complications including infection, skin and fat necrosis. Subgroup analysis compared rates of capsular contracture, implant rupture, implant exposure and overall implant failure in single-stage-direct-to-implant to TE/I. The secondary endpoint was identifying the time interval between surgery with immediate implant-based reconstruction and PMRT associated with lower probability of implant failure. Logistic regression models, Kaplan-Meier estimates and Polynomial regression were used to assess endpoints.
The median follow-up was 43.5 months. 29.3%, 28.3% and 42.4% of the cohort had AR, TE/I and single-stage-direct-to-implant D, respectively. The 5-year cumulative incidence rate of complications was 14.0%, 29.7% and 19.4% for AR, TE/I and single-stage-direct-to-implant, respectively (Log rank p = 0.02). Multivariate analysis showed significant association between TE/I and higher risk of infection (OR 8.1, p = 0.009) compared to AR, while single-stage-direct-to-implant and AR were comparable (OR 3.2, p = 0.2). On subgroup analysis, TE/I was significantly associated with higher rates of implant failure. The mean wait time to deliver PMRT after immediate reconstruction with no adjuvant chemotherapy was 8.4 and 10.7 weeks in single-stage-direct-to-implant and TE/I, respectively (p < 0.005). Delivering PMRT after 8 weeks of surgery yielded 10% probability of reconstruction failure in single-stage-direct-to-implant versus 40% in TE/I.
In comparison to two stages reconstruction, single-stage-direct-to-implant following neoadjuvant chemotherapy has lower complications and offers timely delivery of PMRT.
探讨新辅助化疗后乳腺癌患者接受保乳手术后放疗（PMRT）时，哪种乳房重建类型和时间间隔与较低的并发症发生率相关。
我们回顾了 2000 年至 2017 年在我院接受新辅助化疗、乳房切除术和 PMRT 的 300 例患者的病历。重建类型包括自体皮瓣（AR）、一期直接植入物和两期扩张器/植入物（TE/I）。主要终点是包括感染、皮肤和脂肪坏死在内的重建并发症发生率。亚组分析比较了一期直接植入物和 TE/I 的包膜挛缩、植入物破裂、植入物暴露和总植入物失败的发生率。次要终点是确定手术与即刻基于植入物的重建之间的时间间隔与较低的植入物失败概率相关。使用逻辑回归模型、Kaplan-Meier 估计和多项式回归来评估终点。
中位随访时间为 43.5 个月。队列中分别有 29.3%、28.3%和 42.4%的患者接受了 AR、TE/I 和一期直接植入物 D。AR、TE/I 和一期直接植入物的 5 年累积并发症发生率分别为 14.0%、29.7%和 19.4%（Log rank p=0.02）。多变量分析显示，与 AR 相比，TE/I 与更高的感染风险显著相关（OR 8.1，p=0.009），而一期直接植入物和 AR 相似（OR 3.2，p=0.2）。亚组分析显示，TE/I 与更高的植入物失败率显著相关。在没有辅助化疗的即刻重建后，接受 PMRT 的平均等待时间在一期直接植入物和 TE/I 分别为 8.4 和 10.7 周（p<0.005）。在手术后 8 周时给予 PMRT，一期直接植入物的重建失败概率为 10%，而 TE/I 为 40%。
与两阶段重建相比，新辅助化疗后一期直接植入物具有较低的并发症发生率，并能及时进行 PMRT。
